Improvement is needed in quality and efficiency of care delivered in ICUs. The proposed study is designed to improve Intensive Care Unit (ICU) care and decrease hospital costs . ICUs have been an integral part of the health system since the 1960s, but they are extremely expensive, consuming approximately 0.8% of the GNP. Collaborative interdisciplinary care has been proposed by national panels, providers, researchers, and accreditation agencies as vital for effective care. Collaboration may also influence efficiency. In a study of nurses' and resident physicians' assessment of collaboration in making the decision to transfer patients from a Medical ICU (MICU), nurses' reports of more collaboration were associated with lower patient risk of death or readmission to the MICU. Nurses' satisfaction with that decision making process predicted retention in their positions one year later. Decreasing both ICU readmission and nursing turnover should decrease costs and improve care. The specific aim of the proposed study is to replicate the earlier work in three different ICUs to assess the generalizability of findings and to examine cost effects. Questionnaires will be used to assess general amounts of health care providers' collaboration in practice. At the time of patient transfer the providers caring for the patient will be asked to assess amount of collaboration in making the transfer decision and satisfaction with the decision making process. Patients will be followed for mortality and ICU readmission. Costs will be measured. Severity of illness, a variable that influences outcome and may influence collaboration, will be assessed to control for its effect. Nurse retention will be measured for one year after study initiation. Relationships among collaboration, satisfaction, and providers' demographic variables, education, experience, and age, will also be examined. Based on the findings of this proposed study, future work is planned for an intervention to increase collaboration and an assessment of its effects.